Article Figures & Data
Figures
- Figure 1
Cardiac abnormalities across serial transthoracic echocardiography (TTE). Percentages of patients with TTE abnormalities prior to ischaemic stroke admission, at the time of admission and after admission. (N=373). *Median time from first to the third TTE: 1094 days (IQR 559–1900). AR, aortic regurgitation; EF, ejection fraction; LV, left ventricular; MR, mitral regurgitation; PFO, patent foramen ovale.
Tables
- Table 1
Characteristics of the study cohort
Variable N (%) or mean (SD)
(total n=5523)Gender (male) 2996 (54.3) Age at admission 68.6 (15.2) Race Caucasian 4727 (85.6) African-American 305 (5.5) Asian 175 (3.2) American-Indian 5 (0.1) Native Hawaiian/Pacific Islander 9 (0.2) Unknown/other 314 (5.7) Year of admission 2002–2007 1321 (23.9) 2007–2010 1230 (22.3) 2010–2013 1202 (21.8) 2013–2016 1770 (32.1) Comorbidities Atrial fibrillation/flutter 1119 (20.3) Coronary artery disease/prior myocardial infarction 1185 (21.5) Carotid stenosis 221 (4.0) Diabetes 1292 (23.4) Dyslipidaemia 2216 (40.1) Hypertension 3744 (67.8) Prior stroke 579 (10.5) Prior transient ischaemic attack 183 (3.3) Peripheral vascular disease 237 (4.3) Smoker 826 (15.0) Prosthetic heart valve 46 (0.8) Heart failure 295 (5.3) Chronic kidney disease 181 (3.3) Home medications Antithrombotics 1843 (33.4) Antiplatelet 1574 (28.5) Anticoagulant 269 (4.9) Antihypertensive 3547 (64.2) Statin 2209 (40.0) Presenting symptoms 7.5 (7.1) Aphasia 1657 (30.0) Gaze deviation 1271 (23.0) Field cut 1404 (25.4) Facial weakness 2754 (49.9) Ataxia 698 (12.6) Motor 4379 (79.3) Neglect 936 (16.9) Radiographic findings Cortical infarct 3977 (72.0) Infratentorial infarct 1512 (27.4) Arterial moderate/severe stenosis or occlusion in the head or neck 1673 (30.3) TTE findings Tumour 2 (0.04) Vegetation 14 (0.3) Patent foramen ovale 884 (16.0) Atrial septal aneurysm 70 (1.3) Left atrium, dilated 2411 (43.7) LV aneurysm 91 (1.7) LV thrombus 59 (1.1) LV hypertrophy 1436 (26.0) LV wall motion abnormality 791 (14.3) EF ≤15% 72 (1.3) EF ≤35% 406 (7.4) Lambl’s excrescence 117 (2.1) Mitral annular calcification 2023 (36.6) Aortic atheroma 950 (17.2) Cardiac valvular prosthesis 90 (1.6) Moderate or severe aortic regurgitation 108 (2.0) Moderate or severe mitral regurgitation 609 (11.0) Moderate or severe aortic stenosis 111 (2.0) Moderate or severe mitral stenosis 98 (1.8) EF, ejection fraction; LV, left ventricular; TTE, transthoracic echocardiography.
- Table 2
Findings on TTE during inpatient hospitalisation for ischaemic stroke versus a most recent prior TTE (left) and inpatient TTE versus follow-up TTE (right)
TTE features Comparison of findings of inpatient TTE and most recent prior TTE
(n=1106)Comparison of findings of inpatient TTE and first follow-up TTE
(n=1077)Most recent prior TTE
N (%)Inpatient TTE
N (%)P value Inpatient TTE
N (%)Follow-up TTE
N (%)P value Tumour (left-sided) 0 (0) 0 (0.0) 1.000 0 (0.00) 0 (0.00) 1.000 Vegetation (left-sided) 1 (0.09) 5 (0.45) 0.219 4 (0.4) 1 (0.1) 0.250 Patent foramen ovale 88 (8.0) 131 (11.8) <0.001 258 (24.0) 128 (11.9) <0.001 Atrial septal aneurysm 1 (0.2) 10 (2.9) 0.250 20 (1.9) 5 (0.5) <0.001 Left atrium, dilated 589 (53.3) 632 (57.1) 0.007 490 (45.5) 555 (51.5) <0.001 LV aneurysm 18 (1.6) 25 (2.3) 0.265 20 (1.9) 20 (1.9) 1.000 LV thrombus 6 (0.54) 16 (1.45) 0.031* 18 (1.7) 12 (1.1) 0.327 LV hypertrophy 331 (29.9) 368 (33.3) 0.014* 289 (26.8) 273 (25.4) 0.284 LV wall motion abnormality 201 (18.2) 214 (19.4) 0.287 157 (14.6) 184 (17.1) 0.026 EF ≤15% 2 (0.2) 13 (1.2) 0.001* 16 (1.5) 6 (0.6) 0.031 EF ≤35% 66 (6.0) 104 (9.4) <0.001 95 (8.8) 92 (8.5) 0.810 Lambl’s excrescence 14 (1.3) 30 (2.7) 0.003* 14 (1.3) 18 (1.7) 0.524 Mitral annular calcification 485 (43.91) 545 (49.3) <0.001 366 (34.0) 406 (37.7) 0.003 Aortic atheroma 193 (17.5) 244 (22.1) 0.003* 174 (16.2) 159 (14.8) 0.342 Prosthesis 30 (2.7) 46 (4.2) 0.009* 22 (2.04) 25 (2.32) 0.607 Moderate or severe aortic regurgitation 27 (2.4) 40 (3.6) 0.053 21 (2.0) 28 (2.6) 0.248 Moderate or severe mitral regurgitation 155 (14.0) 177 (16.0) 0.067 116 (10.8) 155 (14.4) <0.001 Aortic stenosis 37 (3.4) 34 (3.1) 0.804 26 (2.4) 32 (3.0) 0.489 Mitral stenosis 25 (2.3) 26 (2.4) 1.000 19 (1.8) 19 (1.8) 1.000 *Median days between most recent prior TTE and inpatient TTE is 539 days (IQR 162–1317 days); median days between inpatient TTEs and follow-up TTE is 481 days (IQR 212–1065 days)
EF, ejection fraction; LV, left ventricular; TTE, transthoracic echocardiogrphy.
- Table 3
Multivariable logistic regression models predicting an abnormal TTE finding (left), a Category I finding (left-centre), a Category II finding (right-centre) and a Category III finding (right) among those with no prestroke history of heart failure
Covariates TTE abnormality
n=4157
OR (95% CI)P value Model c-statistic Category I abnormality
n=981
OR (95% CI)P value Model c-statistic Category II abnormality
n=1519
OR (95% CI)P value Model c-statistic Category III abnormality
n=3535
OR (95% CI)P value Model
c-
statisticOlder age 2.01 (1.73 to 2.34) <0.001 0.71 0.53 (0.45 to 0.62) <0.001 0.68 1.74 (1.50 to 2.01) <0.001 0.73 2.83 (2.48 to 3.24) <0.001 0.75 Male gender 1.22 (1.07 to 1.39) 0.004 Caucasian 1.36 (1.10 to 1.70) 0.005 Coronary artery disease/prior MI 3.44 (2.64 to 4.47) <0.001 3.73 (3.21 to 4.34) <0.001 2.02 (1.66 to 2.45) <0.001 Atrial fibrillation 3.15 (2.40 to 4.14) <0.001 0.61 (0.48 to 0.77) <0.001 1.75 (1.49 to 2.05) <0.001 3.41 (2.71 to 4.29) <0.001 Prior antihypertensive medication 1.32 (1.14 to 1.54) <0.001 0.67 (0.57 to 0.79) <0.001 1.22 (1.05 to 1.42) 0.009 1.84 (1.60 to 2.11) <0.001 Diabetes mellitus 1.28 (1.06 to 1.54) 0.010 0.76 (0.63 to 0.93) 0.007 1.45 (1.23 to 1.71) <0.001 Chronic kidney disease 1.62 (1.02 to 2.58) 0.041 Prior antiplatelet use 0.74 (0.62 to 0.89) 0.002 Admission NIHSS ≥4 0.63 (0.54 to 0.73) <0.001 1.44 (1.26 to 1.65) <0.001 1.17 (1.03 to 1.33) 0.017 Cortical infarct 1.38 (1.18 to 1.61) <0.001 Infratentorial infarct 0.81 (0.68 to 0.96) 0.0139 Patent intracranial and extracranial arteries 1.18 (1.01 to 1.38) 0.043 1.50 (1.26 to 1.78) <0.001 1.29 (1.12 to 1.49) <0.001 MI, myocardial infarction; NIHSS, National Institutes of Health Stroke Scale; TTE, transthoracic echocardiography.
- Table 4
Multivariable logistic regression models predicting an abnormal TTE finding (left), a Category I finding (left-centre), a Category II finding (right-centre) and a Category III finding (right) among those with no prestroke history of heart failure, mechanical heart valve or atrial fibrillation (n=4234)
Covariates TTE abnormality
n=3227
OR (95% CI)P value c-statistic Category I abnormality
n=854
OR (95% CI)P value c-statistic Category II abnormality
n=1062
OR (95% CI)P value c-statistic Category II abnormality
n=2642
OR (95% CI)P value c-statistic Older age 2.05 (1.75 to 2.39) <0.001 0.68 0.50 (0.43 to 0.59) <0.001 0.67 1.81 (1.54 to 2.13) <0.001 0.72 2.90 (2.52 to 3.33) <0.001 0.72 Male gender 1.19 (1.03 to 1.36) 0.016 Caucasian 1.22 (1.01 to 1.48) 0.049 1.31 (1.04 to 1.64) 0.007 Coronary artery disease/prior MI 3.53 (2.66 to 4.68) <0.001 4.17 (3.50 to 4.97) <0.001 2.27 (1.85 to 2.79) <0.001 Prior antihypertensive medication 1.32 (1.13 to 1.55) <0.001 0.65 (0.55 to 0.76) <0.001 1.28 (1.08 to 1.52) 0.004 2.05 (1.78 to 2.37) <0.001 Diabetes mellitus 1.29 (1.06 to 1.57) 0.011 0.73 (0.59 to 0.90) 0.004 1.46 (1.23 to 1.74) <0.001 Prior antiplatelet use 0.75 (0.62 to 0.92) 0.005 Admission NIHSS >4 0.61 (0.52 to 0.71) <0.001 1.55 (1.32 to 1.81) <0.001 1.19 (1.04 to 1.36) 0.013 Cortical infarct 1.44 (1.21 to 1.72) <0.001 Infratentorial infarct 0.80 (0.67 to 0.95) 0.012 Patent intracranial and extracranial arteries 1.22 (1.03 to 1.43) 0.019 1.49 (1.24 to 1.80) <0.001 1.23 (1.04 to 1.44) 0.015 MI, myocardial infarction; NIHSS, National Institutes of Health Stroke Scale; TTE, transthoracic echocardiography.
- Table 5
Multivariable logistic regression model predicting a new abnormal TTE finding (n=83) in those with a prior normal TTE (n=891)
Patient characteristics New TTE abnormality detected
OR (95% CI)P value Model c-statistic Older age 3.78 (1.85 to 7.74) 0.003 0.71 Prior use of cholesterol-lower medication 0.44 (0.27 to 0.73) 0.002 History of coronary artery disease 1.73 (1.04 to 2.89) 0.036 History of carotid disease 0.11 (0.01 to 0.80) 0.029 Peripheral vascular disease 2.65 (1.27 to 5.54) 0.009 Chronic kidney disease 2.53 (1.26 to 5.08) 0.009 TTE, transthoracic echocardiography.
- Table 6
Odds of hospitalisation for recurrent ischaemic stroke, myocardial infarction and heart failure as a function of TTE finding categories
1 year outcomes Category I finding
OR (95% CI)Category II finding
OR (95% CI)Category III finding
OR (95% CI)Hospitalisation for recurrent ischaemic stroke (n=124) 0.54 (0.30 to 0.96)
p=0.03470.77 (0.51 to 1.16)
p=0.20911.25 (0.84 to 1.87)
p=0.2772Hospitalisation for myocardial infarction (n=21) 1.45 (0.53 to 3.97)
p=0.47012.46 (1.04 to 5.80)
p=0.03980.91 (0.36 to 2.24)
p=0.8238Hospitalisation for heart failure (n=28) 1.01 (0.38 to 2.65)
p=0.98955.62 (2.47 to 12.79)
p<0.0001>99 (<0.01 to >999.99)
p=0.9527TTE, transthoracic echocardiography.
